We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) checklist to guide the reporting of this protocol . According to the 2010 Canadian Alcohol and Drug Use Monitoring Survey , 11.2% of Canadians aged 15 years and older reported past-year use of at least one of the following psychoactive substances: cannabis, cocaine/crack, methamphetamine/crystal methamphetamine, ecstasy, hallucinogens, salvia, inhalants, heroin, pain relievers, stimulants or sedatives. The rate of past-year use of any of these substances was higher among males than females (15.3% versus 7.5%, respectively). Rates were also higher among those aged 15- to 24-years-old compared with adults 25 years and older (26.3% versus 8.3%, respectively). Furthermore, among those reporting past-year use, 17% reported experiencing substance use-related harm.
There is also a significant public health burden associated with substance use in Canada. According to 2002 estimates, substance abuse costs Canadians close to $40 billion ($1,267 per Canadian), with use of psychoactive substances (excluding alcohol) accounting for approximately $8.2 billion (20.7%) of the total costs . The vast majority of those costs are associated with Canadians’ lost productivity and health.
For the purpose of this review, non-medical psychoactive substance use includes the use of drugs prohibited by international law including, but not limited to, amphetamine-type stimulants, cannabis, cocaine, heroin and 3,4-methylenedioxymethamphetamine (MDMA) ; the non-medical use of pharmaceuticals such benzodiazepines, opioids or dextromethorphan; and the use of substances such as solvents or inhalants (for example, gasoline, acetone) when they are used for their intoxicating effects. It does not include alcohol, nicotine or caffeine.
The early detection and/or treatment of risky substance use has the potential to dramatically improve outcomes for those who experience harms from the non-medical use of psychoactive substances, particularly adolescents whose brains are still undergoing development. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a comprehensive, integrated approach to the delivery of early intervention and treatment services for individuals experiencing substance use-related harms, as well as those who are at risk of experiencing such harms . The SBIRT model is based on public health principles and procedures, and is designed to reduce the burden of injury, disease and disability associated with the non-medical use of psychoactive substances.
The protocol typically begins with a screening procedure that involves asking questions to evaluate whether the individual has experienced, or is at risk of experiencing, substance use-related harms. Brief interventions (BIs) are typically delivered to those individuals at low to moderate risk of harms; individuals identified as experiencing significant harm and/or having more serious signs of substance dependence warranting formal diagnosis may be referred to treatment services that are outside the scope of BIs.
To evaluate the likelihood that an individual is experiencing, or is at risk of experiencing, substance use-related harms, individuals are screened. Screening may be conducted in a number of different ways. For example, screening may be conducted via psychometrically validated questionnaires or tests developed to accurately categorize users into low, moderate, and high risk categories. Such tests have been developed for different types of substances such as alcohol (Alcohol Use Disorders Identification Test ), cannabis (the Cannabis Use Disorders Identification Test ) or prescription opioids (for example, the Opioid Risk Tool ). General drug screening tests also exist (for example, the Drug Abuse Screening Test ). However, screening tests that reliably categorize users into low or moderate risk groups have not been developed for other substances (for example, heroin and cocaine). For these substances, screening may simply take the form of self-reported use or biological markers indicating use (such as hair, urine, oral fluid or blood) rather than psychometrically validated self-report instruments. In the absence of validated tests or biological markers, others may rely on even less rigorous screening methods, such as the subjective judgment of the individual conducting the assessment. Regardless of the screening method employed, those deemed at risk of harms are typically provided a BI or referred to treatment. In cases where self-reported use or biological markers indicating use are used for screening, it is unclear how practitioners make the decision whether to administer a BI versus referral to treatment.
In reviews where the effectiveness of SBIRT models in reducing harms associated with alcohol use have been evaluated systematically [10–12], few protocols have employed a rigid definition of the screening criteria used to determine whether a BI was administered. This is likely a result of two factors: poor descriptions of screening procedures employed in studies reviewed and/or the heterogeneity of screening procedures employed.
In addition to the variability in screening procedures employed, there is also much variation in how BIs are defined and delivered. In general, BIs are in-person, time-limited efforts to provide information or advice, increase motivation to avoid substance use, or to teach behavior change skills with the aim of reducing substance use and the likelihood of experiencing negative consequences. This variation includes the number of conversations or meetings that take place during intervention delivery as well as the amount of time spent conducting the BI. Reviews such as Kaner et al.  have defined ‘brief’ to mean four or less and note that BIs for alcohol that are provided in primary health care settings are typically delivered within the normal consultation period of 5 to 30 minutes. Levy et al.  suggest that successful BIs typically focus on the following elements (collectively referred to using the acronym FRAMES): feedback on behavior and consequences; responsibility to change; advice; menu of options to bring about change; empathy; and self-efficacy for change.
There is substantial scientific evidence of the benefits of the SBIRT model in primary health care settings as a means to address the harms associated with alcohol use [14–16]. This evidence suggests the SBIRT process can serve as an effective ‘early warning’ system to prevent and/or reduce the serious long-term harms associated with excessive alcohol use. A corresponding analysis for SBIRT targeting the non-medical use of other psychoactive substances is needed.
There is accumulating evidence suggesting that BIs may be effective in reducing the non-medical use of psychoactive substances, such as cannabis [17–21], ecstasy , cocaine [18, 23, 24], benzodiazepines  and opioids [6, 13, 23] among both youths and adults. Traditionally, the SBIRT model has been implemented in primary care settings, emergency departments, inpatient trauma units and other health care settings. These settings see the broadest number and range of patients and thus provide ideal opportunities to screen for, and address, substance use before more severe consequences occur . More recently, however, the protocol is being applied in schools [21, 27] and community settings  in an attempt to reach young people. It is unclear whether the effectiveness of the SBIRT approach is dependent on the setting in which it is applied.
The diversity of substances used and the high prevalence of use and dependence have raised some concerns about the efficacy of a SBIRT protocol for substances other than alcohol . Individuals who use more than one substance or use alcohol and other substances make administering and evaluating SBIRT more complicated than when addressing alcohol alone . Substances have variable forms, costs, risks, consequences and ways for clinicians to identify use. Moreover, most psychoactive substances that are used without medical supervision are illegal or used illegally, which can complicate addressing their use in medical settings by raising patient and physician concerns about confidentiality. Prescription drug misuse presents additional challenges as clinicians struggle to distinguish between appropriate and inappropriate use.
This systematic review will determine the effects of BIs, as part of the SBIRT protocol, on reducing substance use in adolescents and adults identified as experiencing, or at risk of experiencing, harms related to the non-medical use of psychoactive substances (excluding alcohol, caffeine and nicotine). In addition, potential moderating factors that may impact SBIRT effectiveness will be evaluated, if possible.